Virologic Failure?

Jun 6, 2013

Hello doctor Young,

I have been positive since December 2011 and on medication since May 2012. Before the treatment my CD4 was around 450-480 and VL cca 110,000.

I was put on Truvada+Stocrin and my first results went to normal CD4 (520) and VL 216. After 3 months (November 2012)this improved even more to CD4 being 712 and VL only 26. However, my April lab showed CD4 636 and VL 40.

According to my doctor this is still fine and I should keep using the same medication, I am a bit concerned I was not able to reach undetectable levels. I have a couple of questions:

1) I have never missed a dose but sometimes I am up to 60 minutes late. Could this be the reason why I cannot reach <20?
2) If I keep the same regimen in future, is this LLV predicting possible virologic failure?
3) Should I ask my doctor to change my regimen even though I have virtually no side effects from Truvada+Stocrin combo?

Thank you for your valued opinion

Response from Dr. Young

Hello and thanks for posting.

Low level viral loads are almost always of limited consequence-- typically because either of lab error or of activation of the immune system that accompanies minor infections, vaccinations or illness. It's rare that I'll get excited about VLs less than 200 or so.

To your other questions:
-A 1-3 hour shift in dosing has no consequences.
-If you're otherwise tolerating your regimen, I don't believe that your pattern in VL tests warrants a change. Indeed, do make sure that the next time you test that you avoid testing with sinus infections, cold sores or the like... perhaps this is the cause of the issue. Alternatively, one could ask for a different, yet complementary test-- such as a b-DNA test; sometimes this helps sort out these issues.

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